It is hypothesized that the use robotic rehabilitation tables coupled with virtual reality games with elderly stroke survivors residents in skilled nursin facilities (SNFs) will: 1) improve and maintain upper extremity uni-manual and bimanual function, reach, strength and ADL independence; 2) improve and maintain cognition (memory, focus, problem solving); and 3) provide emotive uplifting and maintain it. This implements an integrative, single-point-of-care safe rehabilitation approach. The objectives of the project are 1 to develop a novel uni-manual and bimanual training device that is cheaper and safer than rehabilitation robots; 2) a virtual reality-based adaptable and integrative maintenance program that is clinically effective and engaging for elderly stroke survivors and other patient population. SPECIFIC AIMS 1) to develop the BrightArm Duo system for improving arm/shoulder motion range, shoulder strength, endurance, grasp strength, bimanual function and ADL independence, short-term memory, focusing, executive function and reduce depression in SNF residents chronic post-stroke; 2) to evaluate the new system for rehabilitation and maintenance therapy through a multi-site, longitudinal, randomized controlled study of stroke survivors over a 12 month period. METHODS 1) Construct the BrightArm Duo system by designing and building a new tracking work surface and computerized forearm supports; 2) Develop custom rehabilitation games that incorporate uni- and bimanual motor and cognitive training elements and automatically adapt to each patient. The games should combine to induce >350 repetitions/session; 3) Develop a secure web-accessible database module for game data storage and analysis and ability to play against residents in other SNFs. Data will be sampled transparently in real time during play and uploaded to BCI clinical server; 4) Usability study with healthy elderly adults, to uncover technical problems; 5) Longitudinal, multi-site randomized controlled study with elderly stroke survivors that are residents at two SNFs in New Jersey. Subjects will be randomized into a control group (N=16) and an experimental group (N=32). The control group will continue with existing health maintenance programs. The experimental group will have existing maintenance program plus an additional 8 week initial intensive training, followed by periodic booster rehabilitation sessions. All subjects will have multiple evaluations by blinded clinicians for physical and cognitive/emotive function. Existing maintenance programs at the two facilities will be documented in administration to all study participants. The experimental group will rate the BrightArm Duo therapy usefulness and gained independence in ADLs. NIH RELEVANCE A new device and therapeutic/maintenance method for uni/bimanual arm rehabilitation and cognition/emotive therapy in a single-point-of-care. The approach can be extended to other patient populations with motor and cognitive co-morbidities acute, sub-acute and chronic, adult and paediatric. PUBLIC HEALTH RELEVANCE: Public Health Relevance: Costs associated with stroke are close to 50 billion a year in the United States. A product the simultaneously improves and maintains arm uni-manual and bimanual function, increases arm strength, improves ability to focus and memory, and lifts morale benefits elderly stroke survivors and other patient populations (traumatic brain injury, post-traumatic stress disorder, chronic pain, Alzheimer's Disease, pediatric). The product facilitates a single-point-of-care therapy that reduces health care costs.